Forum Powerpoint_150323

Provider Forum

15 March 2023

Whakataka te Hau

Karakia Timatanga (opening)

Whakataka te hau ki te uru

Whakataka te hau ki te tonga

Kia mākinakina ki uta

Kia mātaratara ki tai

E hī ake ana te atakura

He tio, he huka, he hau hū

Tīhei mauri ora!

Cease the winds from the west

Cease the winds from the south

Let the breeze blow over the land

Let the breeze blow over the ocean

Let the red-tipped dawn come with a sharpened air

A touch of frost, a promise of a glorious day

Session Phil Back, GM – Network Services, WBoP PHO 7 to 7.15

Dr Vaughan Poutawera, Deputy HOD

Hauora a Toi Bay of Plenty

to 7.35

Surgery Update for the WBOP

Brent Gilbert-De Rios & Gina Burney, Immunisation Leads, Hauora a Toi Bay of

to 7.55 PM

Dr Claire Isham, Clinical Director, WBoP PHO

Dr James Peckett, Clinical Advisor, WBoP

to

Dr Claire Isham, Clinical Director, WBoP PHO

Kate Banuve, Smoking Cessation Facilitator, WBoP PHO

Naomi Malcolm, Primary Mental Health

Programme Lead, WBoP PHO

Melanie Rundell, Social Worker, WBoP PHO

Michelle Lowry, Mental Health Registered

Nurse, WBoP PHO

to 8.20

to

PHO Update

Phil Back

General Manager – Network Services

Western Bay of Plenty Primary Health Organisation

PHO UPDATE

Health Reforms:

• Iwi Māori Partnership Board

• Regional Wayfinders

• National Director of Commissioning, Te Whatu Ora

• Te Whatu Ora major restructure

• Locality development

• Pay parity for Nurses working in primary care

Iwi Māori Partnership Board

• Te Moana a Toi IMPB is now fully mandated.

• A key function for IMPBs is to receive and sign off on locality plans.

• Our IMPB is currently working on a framework and criteria for assessing locality plans – this will be shared to guide locality plan development.

• We are pressing ahead, working in partnership with our BOP PHO colleagues and Te Whatu Ora Hauora a Toi BOP, to determine what our locality structure could look like.

Regional Wayfinders

• Four Regional Wayfinders nationally have been appointed.

• One for each of the four Regions; Northern, Te Manawa Taki, Central and Te Waipounamu. • They have regional responsibility for Commissioning of services across Primary and Community Care.

• Te Manawa Taki Wayfinder is Nicola Ehau.

National Director of Commissioning

• Abbie Anderson has been appointed at National Director od Commissioning, Te Whatu

Ora.

• Previously lead development of Medicare Locals (Australian version of PHOs) in Queensland.

• Has indicated that she wants to take a deliberate approach to Commissioning with one of her first principles being “nothing stupid”.

• PHO CEOs are meeting with Abbie tomorrow to seek further clarity around the role of PHOs/Network Support organisations in supporting locality plan implementation.

Te Whatu Ora major restructure

• Te Whatu Ora is going through a major restructure which will impact local and regional roles.

• National, regional and district level roles required to deliver the new operating model for the hospital and specialist and community / provider arm.

• We currently still have a Planning and Funding team at district level.

• Expecting some significant changes to the contracting / funding model

Locality development

The following slides, courtesy of Te Whatu Ora, provide an overview of:

Locality purpose

Locality intent, and

Locality boundary determination

What is a locality?

• A locality is a geographical area that is home to a community with their own specific health and social needs and aspirations that the system will plan and arrange services to meet.

• Localities give iwi, mana whenua, hāpori Māori and communities a strong voice in deciding what’s needed in their local area.

• Localities enable different health and wellbeing organisations to work

• together better to improve people’s health and wellbeing.

• By July 2024, every community in New Zealand will be part of a locality.

• Te Whatu Ora will support all people living in localities to say what they need to live well in and thrive in their communities.

• Iwi-Māori Partnership Boards will ensure whānau Māori living in a locality are supported to say what they need.

Localities seek to embed a population health approach

The Locality approach recognises that if we can create better connections across health and social care agencies, we can better promote health and wellbeing and lift the health outcomes of entire communities.

Localities will embed a population health approach where Wai Ora, Mauri Ora and Whānau Ora are all addressed through the social determinants of health – the circumstances in which people are born, grow, live, learn, work and age, to improve outcomes.

12 Locality Prototypes

Locality boundary determination process

Pay parity for Primary Care Nurses

• Work at a national level is underway to address the pay disparity between

• Unlikely to match Te Whatu Ora rates but apparently will go a long way toward addressing current disparity

• Expected that funding will flow via Capitation as the principle means for funding this. Other options need to be identified for non-capitated service provision

• JBTW (national work also underway around an equity adjuster for capitation)

After Hours Services Report

• Providers Inc. has received the final After Hours services Report, completed by Staywell Ltd.

• Work now underway to progress initial recommendations from the Report including:

- Data analysis of presentation trends for ED and 2nd Ave

- Exploring virtual service provision options to enhance current environment

- Roster modifications – both shift length and NP inclusion

• Current Telephone Nurse Triage arrangement with Whakarongarau to be exited

• Facilitated stakeholder working group to be established to guide these developments.

Orthopaedic Surgery Update for the WBOP

Dr Vaughan Poutawera

Deputy HOD Orthopaedics, Hauora a Toi Bay of Plenty

Update on Hauora a Toi Bay of Plenty Immunisation Strategy

Local engagement

Knowledge gained through the rollout of our Covid-19 vaccination programme supports the provision of a wide variety of delivery models:

• Gp Providers

• Pharmacies

• Community Drop-in/Pop-up centres

• Iwi and Pasifika providers

• Outreach Immunisation Teams

Outcomes sought

• Vaccination coverage rates for Maori and key vaccinations for the BOP population and communities are improved

• Local support for `Lifespan` approach to all vaccinations in place

• Additional services through Hauora and Community providers, who design and deliver tailored vaccinations to their populations

• Assistance with systems is timely and useful to new delivery models

• Equitable access to vaccination through multiple routes

• Accessible and relevant resources available for both consumers and providers

Current Immunisation Projects Underway

Hapu Mama Vaccination

• Hauora a Toi is collaborating with Tauranga and Whakatāne Hospital

Midwifery, along with antenatal clinic midwives in Katikati and Te Puke to offer and vaccinate hapū māmā during routine antenatal clinics

• An Immunisation ‘Cheat Sheet’ for LMC’s and providers of maternity services has been developed and approved by IMAC – the purpose to support initiating conversations and raising awareness of immunisation and its importance

• External stakeholders & WCTO providers have been contacted to reinforce referral pathways for OIS services

MMR/Childhood

additional

funding facilitation

for 3 PHO’s and Community Providers

• The three Bay of Plenty Primary Healthcare Organisations and our Iwi Community OIS providers are discussing a collaborative, increased focus on MMR (measles, mumps & rubella) immunisations for tamariki across the rohe including concomitant delivery of other immunisations which may be due/past due.

• This collaboration will be equity-focussed and supported by flexible resourcing from Te Whatu Ora – Hauora a Toi Bay of Plenty’s OIS across booking, recalls, and vaccination clinics and limited additional funding.

• Successful weekend clinics have already taken place, calling campaigns supported, pop-up clinics planned for Hauora Family Day etc.

OIS – referral support

Volumes for OIS teams – referrals pre Hauora a Toi additional support: Volumes for OIS teams – referrals post

• Hauora a Toi OIS broadened the Covid Immunisation Team to support OIS referrals for 2yr and 5yr health targets. This was in acknowledgement of the consistently high referral rate which couldn’t be supported by existing resources.

• PHO and PHA able to concentrate on 8m health target in acknowledgement of its priority

• All referrals continue to be encouraged to engage with GP services through timely enrolment

HPV – Immunisation Programme

• HPV immunisation rates remain low, these have been impacted by Covid-19 but historically, low uptake prevails

• Over 10,000 doses are outstanding within the Bay of Plenty – those who missed due to lockdown and programme suspension during the pandemic response.

• Hauora a Toi Bay of Plenty will be working collaboratively with all key stakeholders to plan and deliver a catch-up programme

Vaccinator workforce training

• Thank you to all the GP providers who collaborated with the upskilling of provisional or authorised vaccinators to deliver childhood immunisations.

• This will be an ongoing piece of work and we appreciate your help!

• Approximately 25 vaccinators have been through this upskilling programme. Priority for placements is given to iwi and Māori communitybased vaccine providers.

Priority Matrix

• Developed by Northland Region in response to low vaccination rates among Maori and Pasifika populations

• Endorsed by Te Whatu Ora Executive Leadership team and Health NZ for use across the rohe.

• Intention: To support prioritisation of vaccination by ethnicity and by scheduled event where appropriate eg OIS programmes, catch-up and calling campaigns, allocation of resources etc.

• All Districts have been requested to ‘sense check’ our vaccination delivery, utilising the Matrix as a tool to assist programme planning

Ongoing programmes and planning

• Mpox vaccination delivery including fixed site clinics in EBOP and WBOP

• Covid-19 ‘Winter Wellness’ bivalent booster, Paediatric and Infant dose deliveries plus calling campaigns

• MenB programme – introduction planning, potential catch-up programme investigation

Outreach Referrals –Advanced Pathway

• Developed through collaboration with Immunisation Coordinators and GP Liaison teams • Enables GP providers to refer any tamariki requiring the 8m health target vaccinations for OIS services without having to wait until overdue timeframes.

Maori or Pasifika tamariki may be referred for OIS services for ALL eligible vaccinations without having to wait until overdue

All overdue timeframes have been reviewed to support GP referral at an earlier timeframe • This will be rolled out in the coming few weeks

Additional provider support

• Immunisation recording and referral system Kotahi has been adopted by Iwi Outreach providers, Pasifika providers to be onboarded shortly

• Until AIR is fully developed, Community Iwi and Pasifika providers are being given National Immunisation Record (NIR) access through the Connected Health system, allowing them to check client’s immunisation status. This is currently supporting Rangiora, Te Ika Whenua Hauora (Murupara), Te Pou

Oranga O Whakatōhea Social & Health Services (Ōpōtiki), Te Puna Ora o

Mataatua and Waiariki Whanau Mentoring (Whakatane).

• Māori and iwi providers continue to be supported by Hauora a Toi Immunisation Team where required.

Ngā mihi nui

PHO Clinical Update

Dr Claire Isham, Clinical Director, WBOP PHO

Dr James Peckett, Clinical Advisor, WBOP PHO

Skin Lesion Service has transitioned to Halcyon

• Went live mid February 2023

• Referrals made via Halcyon. User guide on the Patient Services Guide portal page https://portal.wboppho.org.nz/images/documents/Skin_Lesion_Service_%E2%80%93_Guideline_Feb_2023. pdf

• Photos are compulsory – the referral will not submit without photos attached

• There is an additional guideline on saving photos to your desktop or PMS HERE

• Referring clinicians will receive a notification with outcome from each referral

Referrals to the PHO Diagnostic Breast Imaging Programme

• This programme is for the investigation of people where there is a suspicion of breast malignancy

• We are receiving an increasing number of referrals relating to noncancer issues which have to be declined and rereferred via other channels

Revised and expanded eligibility criteria for influenza vaccine 2023

• Revised and expanded criteria for 2023. Widened access for the following two groups:

• Children who are 6 months to 12 years of age

• Māori and Pacific peoples who are 55 to 64 years of age.

https://pharmac.govt.nz/news-and-resources/consultations-and-decisions/2023-03-02-decision-to-widen-access-toinfluenza-vaccine

Monkey Pox - funding extended to June 2023

Have you signed up for celo yet?

• Download the app from this website: https://www.celohealth.com/

• Then text GP Liaison Dr Chris Tofield on 0221501058 and he can text you an invitation link. Any questions, feel free to contact Chris as well. baynav@bopdhb.govt.nz

Check STI Molecular Kits – Expiry Date (Pathlab)

• Recently there have been numerous STI specimens received in the laboratory with expiry date 25/02. This has caused the specimen to be rejected, resulting in a recollect of specimen for the patient.

EpiPens fully funded from 1st Feb

Epipen: What people need to know - Pharmac | New Zealand Government

Victoza® (liraglutide injection) now funded for people with type 2 diabetes

From 1st March 2023, Victoza® (liraglutide injection) will be funded by Pharmac for patients with type 2 diabetes who meet the current eligibility criteria for GLP-1 receptor agonists.

An alternative to Trulicity for those who would benefit from GLP-1 receptor antagonists.

Research Request: COVID's impact on Respiratory Presentations

Invitation to participate sent to Practice Managers on February 20.

The research will provide an accurate picture of the incidence of respiratory infection presenting through general practice over the last ten years, and in particular, explore the impact of COVID-19 on the presentations to General Practice.

Practices will be asked to participate in one or two phases of the study. Phase 1 involves the capture of a small set of deidentified clinical notes from consenting practices.

Contact is Rachel Blanch Rachel@datacraft.nz

Referring to Epilepsy NZ via BPAC

Their service is nationwide and includes supporting patients and their whanau with management plans, advocacy for services, accessing MSD, support for schools/workplaces where there may be a student or employee with epilepsy.

https://epilepsy.org.nz

Covid Updates

Evusheld no longer indicated

Molnupiravir no longer recommended as antiviral treatment

Covid Vaccine - new bivalent now available for booster doses. Catch up campaign until the end of March then broad access from 1st April for every one over 30 (and those >16yrs who are at increased risk of severe illness) who has completed a primary course and not had covid or a booster in the last 6 months

Smoking Cessation Update

Dr Claire Isham - Clinical Director

Kate Banuve – Smoking Cessation Facilitator

Western Bay of Plenty Primary Health Organisation

Smoking Cessation Facilitator

• Support WBOPPHO practices to achieve the Brief Advice Target

• Support champions to deliver in practice Smoking Cessation

• Answer any smoking cessation queries

• Available for training around smoking cessation

• Strengthen referrals to Hāpainga community stop smoking service + Heru and Hapū Māmā wananga

• Promote World Smokefree May in practice and community

• My hours = Monday/Tuesday and Thursday

Smokefree Targets – How are we tracking?

• Smokefree 2025 – Less than 5% of NZ will be daily smokers by 2025

2015 = 15.1% 2022 = 8%

WBOPPHO Current Smokers = 10.6% (Māori 23.7% vs Non-Māori 8.3%)

• Brief Advice Target – 90% of all smokers are given brief advice within a 15month period.

WBOPPHO March 2023 = 81.2%

• Wāhine Māori daily smokers across NZ at an all time low

2021 = 24.1%

2022 = 18.2%

Hāpainga referrals from WBOPPHO

**In the past 2 quarters, Hāpainga have had a successful quit rate of 80% at 4 weeks for those who set a quit date with them** (validated with CO readings)

What’s working?

• Vensa text campaign (only available for MT currently)

• Having a Smokefree Champion

• Utilizing Patient Prompts

• Referring to Hāpainga (through best practice)

• Collaborative team effort

• Phone calls from Karo list monthly

• Ensuring staff know how to correctly classify so that their work is counted

Spotlight on Practices

Healthcare on Fifteenth

Bethlehem Medical Centre

October 2022 = 16.1%

March 2023 = 95.9%

October 2022 = 16.3%

March 2023 = 99.2%

• Classifying notes from recent visits

• Vensa text campaign

• Cold calling from Karo list

New Smoking Cessation

Champion

• Texts/calls to current smokers from Karo list

Clinical Update

• Combination NRT more effective than single products – aim to use for 8 weeks

• Varenicline (Champix) supply still on hold

• Vaping – increasing evidence to support daily vaping with a nicotine product as a part of a quit attempt – is a focus of ongoing Cochrane reviews

• Vaping is safer than tobacco but long term safety concerns remain. Ideally aim to stop vaping as well or only use very occasionally

• Young people – minimal research in this group - still aim for step wise reduction in nicotine exposure

• Pregnancy - NRT (short acting) remains safest option

Consideration for specific Groups

• Māori – current smoking cessation programmes and approaches have been shown to be just as effective and acceptable to Māori - challenge is getting the information out to the target groups

• Patients with Severe Mental Health diagnosis – often underestimate their nicotine intake. Require medication adjustment as they reduce nicotine intake e.g. Olanzapine

Key Resources

• MOH ABC Smoking Cessation training available online for staff needing a refresher: https://nts.org.nz/abc-e-learning

• New Zealand Guidelines for Helping People to Stop Smoking 2021 Update (health.govt.nz)

• Guide to Prescribing Nicotine Replacement Therapy

• The ABC Pathway - Key messages

• October 2022 Smoking Cessation

• Hâpainga Programme information

• Heru Hapū Māmā Programme information

Any Questions?

Please feel free to contact us:

Kate.Banuve@wboppho.org.nz

clairei@wboppho.org.nz

Coordinated options Primary Mental Health Introductions and Update

Naomi Malcolm

Introductions

• Michelle Lowry

• Mental Health Registered Nurse • Mel Rundell

• Registered Social worker

Extended Consultations

• Halcyon

• Allocations but descretionary criteria applied (target Populations)

• Maori / Pacifika

• Youth >19

• Postnatal / Parenting

• Those declined at secondary

• Reviewed

• No ability to review notes in PMS

Mental Health Support

• Triage and identification of needs and appropriate treatment options

• Prioritisation of target populations

• Packages of Care 3-6 sessions of Individual Counselling

• Group Programme remains paused

• Navigation and support towards other appropriate treatment options

• Guided by organisational values and principles of care

• Person/Tāngata centred

• Trauma informed

• No missed opportunities for intervention

• Any door is the right door, avoid the ‘bounce’

• Maintain chain of care

• Corrective experiences

• Clinical pathway

Social Work

• Embedded across triage process

• Assess and provide intervention

• Social determinates of health

• Access to resources

• Advocacy • Navigation • Underpinned by equity

Please Consider

• Limitations of service

• no additional funding for this value-added service

• Information from Specialist Services

• no access to Te Whatu Ora PMS

• Previous input

• Health Improvement Practioners

• Not able to facilitate diagnosis

Future

• Continue to advocate for adequate funding and resourcing

• Database upgrade

• Integration across sector and community agencies

Kia tau

Karakia whakamutunga (closing)

Kia tau kia tātou katoa

Te āio, te aroha me te marutau

Tīhei Mauri Ora

May peace, love and safety

Be upon us all

Let there be life